Symptoms & Diagnosis
Many people living with RLS are misdiagnosed or not diagnosed at all. There is often confusion about what the symptoms of RLS are and/or whether a person has these symptoms. Use the symptom checker below to see if you might have RLS.
The International Restless Legs Syndrome Study Group (IRLSSG) proposed a set of RLS diagnostic criteria. Diagnosis of Restless Legs Syndrome can be made if all of the five criteria are met:
1. A need to move the legs, usually accompanied or caused by uncomfortable, unpleasant sensations in the legs: Any kind of sensation may be a manifestation of RLS and a wide variety of descriptions have been used ranging from "painful" to "burning" - some people say it feels like they have insects inside their legs or arms. Sometimes the need to move is present without the uncomfortable sensations and sometimes the arms or other body parts are involved in addition to the legs.
2. The need to move and unpleasant sensations are exclusively present or worsen during periods of rest or inactivity such as lying or sitting.
3. The need to move and unpleasant sensations are partially or totally relieved by movement such as walking or stretching at least as long as the activity continues.
4. The need to move and unpleasant sensations are generally worse or exclusively occur in the evening or night.
5. Symptoms are not solely accounted for by another condition such as leg cramps, positional discomfort, leg swelling or arthritis.
RLS often causes difficulty in falling or staying asleep, one of the chief complaints of the condition. Many people who have the disease also have Periodic Limb Movements (PLM) - jerking of the arms or legs that is often associated with sleep disruption.
A single question for Rapid Screening
The European Journal of Neurology reported a new single question for the rapid screening of RLS in the neurological clinical practice - "When you try to relax in the evening or sleep at night, do you ever have unpleasant, restless feelings in your legs that can be relieved by walking or movement?“. This question has 100% sensitivity and 96.8% specificity for the diagnosis of RLS.
It is recommended that patients with RLS are given the following tests by their medical practitioner, as a minimum:
- Serum ferritin: RLS is frequently associated with iron deficiency.
- Renal function: RLS may be associated with renal failure.
- Other investigations for underlying possible cause include fasting blood glucose, magnesium, TSH, vitamin B12 and folate.
- If the neurological examination suggests an associated peripheral neuropathy or radiculopathy, electromyography and nerve conduction studies should be undertaken.
RLS SEVERITY SCALE
A scoring system for RLS symptom severity has also been developed by the IRLSSG. It is used in clinical trials and other studies to evaluate therapeutic effects of treatment.
Diagnosis of the severity of RLS is done through a series of 10 questions, each scored using a RLS rating of 0 to 4 and therefore leading to a maximum total score of 40.
The severity of RLS symptoms are scored as:
Mild (total score of 1-10)
Very severe (31-40)
The patient’s score can be used to decide whether pharmacological treatment would be beneficial.
Refer to a neurologist or sleep specialist if:
- There is insufficient initial response despite adequate duration and dose of treatment.
- Response to treatment becomes insufficient despite an increased dose.
- Side-effects are intolerable.
- The maximum recommended dosage is no longer effective
- Augmentation develops (onset of symptoms earlier in the day, increased severity of symptoms, or the spread of symptoms to different parts of the body, such as the arms, trunk or face)
Children with RLS should not be treated in primary care.
Resources for Professionals
Welcome to our resources for medical professionals. We regularly receive feedback that medical practitioners want to learn more about RLS. We hope the resources on these pages help.
The Management of Restless Legs Syndrome: An Updated Algorithm, June 2021
Michael H. Silber, MBChB; Mark J. Buchfuhrer, MD; Christopher J. Earley, MBBCh, PhD; Brian B. Koo, MD; Mauro Manconi, MD; John W. Winkelman, MD, PhD for theScientific and Medical Advisory Board of the Restless Legs Syndrome Foundation
Abstract: Restless legs syndrome (RLS) is a common disorder. The population prevalence is 1.5% to 2.7% in a subgroup of patients having more severe RLS with symptoms occurring 2 or more times a week and causing at least moderate distress. It is important for primary care physicians to be familiar with the disorder and its management. Much has changed in the management of RLS since our previous revised algorithm was published in 2013. This updated algorithm was written by members of the Scientific and Medical Advisory Board of the RLS Foundation based on scientific evidence and expert opinion. A literature search was performed using PubMed identifying all articles on RLS from 2012 to 2020. The management of RLS is considered under the following headings: General Considerations; Intermittent RLS; Chronic Persistent RLS; Refractory RLS; Special Circumstances; and Alternative, Investigative, and Potential Future Therapies. Nonpharmacologic approaches, including mental alerting activities, avoidance of substances or medications that may exacerbate RLS, and oral and intravenous iron supplementation, are outlined. The choice of an alpha2-delta ligand as first-line therapy for chronic persistent RLS with dopamine agonists as a second-line option is explained. We discuss the available drugs, the factors determining which to use, and their adverse effects. We define refractory RLS and describe management approaches, including combination therapy and the use of high-potency opioids. Treatment of RLS in pregnancy and childhood is discussed.
Read the full article here (opens in a new window)
RLS drugs side effects.
RLS severity scale.